A scheme which helps people in Edinburgh with complex mental health needs into work is set to be shut down as part of a £33 million cut to the city's health and social care budget.
Sweeping cutbacks to help bridge an "unprecedented" funding gap have been unveiled as health bosses warn the measures could reduce the "quality and level" of care that is provided in the capital.
A "longer-term transformation" of services has been promised however, which is said will introduce a more strategic approach to how funds are spent.
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Plans to shave millions off the budget for Edinburgh Health and Social Care Partnership (EHSCP), set to be approved next week, include cutting the number of care home beds as well as funding for community care equipment and transportation for service users.
Trade union Unison said while being presented as savings, the measures brought forward would result in "the deepest of cuts" which would cause "untold suffering for our most vulnerable citizens".
An employability scheme which supports adults with complex mental health difficulties find work and further education opportunities will be closed for good if councillors and NHS staff sitting on the Edinburgh Integration Joint Board, which has oversight of EHSCP, approve the financial plan.
'The Works' currently helps 41 individuals with illnesses such as schizophrenia and bipolar disorder, with nine people on the waiting list. A report setting out the impact of this cut said users would be at "increased risk of social isolation and loss of hope".
Other proposals include reviewing how patients' care needs are assessed to prioritise those most in need, reducing spending on agency workers and staff overtime and having more 'grip and control' over use of contracted services.
In addition it is proposed 55 care home beds to support people who are "medically fit to leave hospital but are awaiting some form of additional support" will be decommissioned after Scottish Government funding was pulled, reducing the deficit by £1.6m.
However, even if all the measures are approved it will not result in a balanced budget, with a £14m gap remaining.
And closing this could require drastic further cuts, which officials have recommended are not progressed as they would have "wide ranging impacts".
These include closing some non-residential care units, increasing the occupancy of care homes to reduce the overall number of facilities and reducing grants to third sector organisations which support the "marginalised, disadvantaged, migrant population and those in poverty and homeless".
However, a report said "doing nothing" would result in "an estimated deficit of £59m by April 2025".
It said: "We are facing unprecedented challenges to the sustainability of our health and care system; an ageing population; an increase in the number of people living with long term conditions; a reduction in the working age population which compounds the challenge in workforce supply, and fundamentally resource availability cannot continue to match levels of demand.
"These issues are long-standing and have been recognised on a UK and Scotland wide basis.
"Opportunities to deliver further efficiencies in the timescale required and, at the same time maintain performance and improve outcomes for people, have now been exhausted. Savings beyond the level currently built into the plan will have a significant negative impact on performance gains and, ultimately on outcomes for people."
David Harrold, service conditions convenor for Unison's Edinburgh Council branch said: "This package is being presented as savings, when the reality is they are the deepest of cuts which will cause untold suffering for our most vulnerable citizens.
"Closing Edinburgh’s care homes and respite services will not only marginalise but will isolate our older people. These are the people who raised us and loved us, yet there are those who would take them away from their homes just to balance the books. A civilised society should not allow this.
"Cutting funding to the many voluntary sector organisations that provide essential services to our communities will cause a catastrophic burden on services elsewhere.
"Who will care for those with mental health issues or drug addiction? Who will offer a helping hand in their absence? Without these organisations we run the very real risk of an increase in crime, suicide, and homelessness. Again, a civilised society should not allow this.
"It seems that the Edinburgh Health & Social Care Partnership and the Integration Joint Board have forgotten that they are here to ensure the safety and wellbeing of the old and vulnerable of our city."
Mr Harrold said the union was urging members of the Intergrated Joint Board to "not to serve the bottom line but to demand more funding from the Scottish Government".
An EHSCP spokesperson said: “Despite the huge challenges posed by a 47m pound budget deficit we have been able to put together a package of reforms which will not only cut the deficit in a manageable way over 3 years, it will allow us to improve services for the people of Edinburgh.
"With smarter commissioning, use of technology and better care plans we can close the gap over 3 years whilst protecting vital services and driving our Improvement Plan for more person-centred care.”
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